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Granulomatosis With Polyangiitis Presenting as Pulmonary Nodules: A Case Study and Literature Review
Yanghang Chen1, Haihong Zheng2, Liuyang Gong1
1Department of Respiratory and Critical Care Medicine, Zhejiang Taizhou Hospital, Linhai, China.
Abstract:
This article presents a case of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-positive granulomatosis with polyangiitis (GPA) presenting initially as chronic cough. Pulmonary shadows persisted and progressed despite antibiotic therapy. The diagnosis was confirmed by lung biopsy showing granulomatous inflammation with vasculitis, and the patient improved significantly with glucocorticoids combined with cyclophosphamide. This report, supplemented by a review of relevant literature, aims to enhance clinical awareness of this disease and emphasizes the importance of considering vasculitis and obtaining pathological confirmation in cases of refractory pulmonary lesions.
Insights
This case study highlights myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-positive granulomatosis with polyangiitis (GPA) initially presenting as chronic cough. Early diagnosis and treatment with immunosuppressants are crucial for managing refractory pulmonary lesions.
Area of Science:
- Rheumatology
- Pulmonology
- Pathology
Background:
- Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis.
- Pulmonary involvement in GPA can manifest insidiously, mimicking other respiratory conditions.
- Myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA) are associated with GPA, but presentation can vary.
Purpose of the Study:
- To report a case of MPO-ANCA-positive GPA presenting with chronic cough and refractory pulmonary lesions.
- To emphasize the importance of considering vasculitis in undiagnosed pulmonary conditions.
- To review literature and enhance clinical awareness of GPA's diverse pulmonary manifestations.
Main Methods:
- Case presentation of a patient with MPO-ANCA-positive GPA.
- Diagnostic confirmation via lung biopsy revealing granulomatous inflammation and vasculitis.
- Therapeutic intervention with glucocorticoids and cyclophosphamide.
- Literature review on GPA with pulmonary involvement.
Main Results:
- The patient presented with chronic cough and persistent pulmonary shadows unresponsive to antibiotics.
- Lung biopsy confirmed granulomatous inflammation with vasculitis.
- Significant clinical improvement was achieved with immunosuppressive therapy.
Conclusions:
- MPO-ANCA-positive GPA can present initially with non-specific respiratory symptoms like chronic cough.
- Refractory pulmonary lesions warrant investigation for underlying vasculitis.
- Pathological confirmation and timely immunosuppressive treatment are vital for favorable outcomes in GPA.
